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Category : News Coverage

Becker’s Hospital Review: Medicare RACs, Hospitals Spar Over New Fraud Legislation

  A bill that would reform Medicare recovery auditing practices has spurred tensions between hospitals and RACs. FROM BECKER’S HOSPITAL REVIEW: “Last month, House Reps. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.) reintroduced the Medicare Audit Improvement Act. Under this bill, Medicare RAC record requests would be capped to 2 percent of hospital claims, with a maximum of 500 medical record requests every 45 days, among other measures. The American Coalition for Healthcare Claims Integrity, a non-profit RAC supporter group, argued […]

Fierce Healthcare: Hospitals, Auditors Clash Over RAC Reform

  Medicare recovery auditors (RACs) are fighting a house bill that would cut into billions of dollars in Medicare fraud recoveries.   FROM FIERCE HEALTHCARE: “If you want to send Medicare crashing to the ground, letting improper payments run rampant is a surefire way to do that,” Amanda Keating, a spokeswoman for the American Coalition for Healthcare Claims Integrity, told The Hill’s Healthwatch. She noted RACs recovered more than $2 billion in improper payments in 2012 alone, Healthwatch reported.   Read the full […]

Bloomberg: Pacific Health Corp. Closes 3 Hospitals Due to Fraud Allegations

  Pacific Health Corporation officials said they will close their three remaining hospitals this week after allegations that the facilities recruited homeless people to fraudulently bill Medicare. FROM BLOOMBERG: “Department of Justice officials announced in August that Pacific Health agreed to pay a $16.5 million for allegedly engaging in an illegal kickback scheme in which homeless people were recruited from Los Angeles’ Skid Row to become patients and bilk the system. As part of the settlement, PHC’s Los Angeles Doctors […]

The Hill: Feud between hospitals, Medicare contractors explodes over fraud bill

  Recovery audit contractors are pushing back on new legislation that weakens oversight of Medicare payments. FROM THE HILL:  RACs charge that the new bill from Reps. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.) will severely undercut their efforts to secure Medicare’s finances at a time when improper payments are rife within the program. A spokeswoman for the American Coalition for Healthcare Claims Integrity, a nonprofit coalition, pointed to more than $2 billion recovered for Medicare by RACs in 2012. […]

CBS: U.S. Attorney’s Office Sees Uptick in Health Care Fraud Cases

  In this video, the U.S. Attorney’s Office reports that healthcare schemes previously uncovered in Miami are now on the rise in West Michigan. FROM CBS NEWS GRAND RAPIDS, MI: “In fiscal year 2012, the Department of Justice recovered $3 billion of taxpayer money by cracking down on health care fraud. “Taxpayers are definitely the ultimate victim here, and that means everyone is suffering when people are abusing the system,” said U.S. Attorney Pat Miles. We’re told that schemes that […]

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FBI: Medical Equipment Company Owner Arrested in 21-Count Health Care Fraud Indictment

  Authorities arrested Andrea Michelle Tellison, owner of Texas Durable Medical Company, following a 21-count indictment charging her with healthcare fraud and aggravated identity theft. From the FBI Website: Durable Medical Equipment Company Owner Arrested in 21-Count Health Care Fraud Indictment HOUSTON—Andrea Michelle Tellison, 46, has been arrested following the return of a 21-count indictment charging her with health care fraud and aggravated identity theft, United States Attorney Kenneth Magidson announced today. The indictment was returned under seal Wednesday, March 20, […]

RACMonitor: Fallout Continues over Audit Reform Bill

  The Medicare audit reform bill, introduced by Reps. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.), will weaken the federal government’s flagship healthcare program. FROM RACMonitor:  “Every year, more than $65 billion in improper payments are made to healthcare providers due to fraud, waste, abuse, and billing errors,” Amanda Keating, a spokesperson for the American Coalition for Healthcare Claims Integrity, said in a written statement to RACmonitor. “This puts a tremendous burden on a Medicare system already struggling to remain […]

POLITICO Pulse: Medicare Fraud Proposal Takes Lumps From Defenders of Contractors

  POLITICO Pulse exposes the special interests driving RAC reform efforts in the House. FROM POLITICO PULSE:  It didn’t take long for the bipartisan harmony presented by the sponsors of the Medicare Audit Improvement Act to devolve into a mud fight. Primary sponsors, Rep. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.), presented the bill as an effort to ease the administrative burden on small hospitals by restricting Medicare fraud contractors’ ability to make onerous document requests. But a chorus of […]

The Hill: Bill seeks to ease Medicare audit burden

  Reps. Sam Graves (R-Mo.) and Adman Schiff (D-Calif.) have introduced new legislation to limit auditing activities within a certain timeframe. FROM THE HILL’s HEALTHWATCH: The measure would limit the number of “additional document requests” to two percent of hospitals claims, with a maximum of 500 per 45 days. It would also penalize auditors that ignore basic audit requirements and courtesies. A non-profit anti-fraud group criticized the bill. “While we have not had an opportunity to review the legislation in […]

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FBI: Houston-Area Doctor Sentenced for Role in $17.3M Medicare Scheme

  From the FBI Website: Houston-Area Doctor Sentenced to 63 Months in Prison for Role in $17.3 Million Medicare Fraud Scheme WASHINGTON—A Texas doctor was sentenced today to serve 63 months in prison for conspiring to commit health care fraud by falsifying plans of care for Medicare beneficiaries, including patients whom he did not treat, as part of a $17.3 million Medicare fraud scheme. Today’s sentence was announced by Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney […]